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General NPI Number Information
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NPI Number | 1962582569
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Entity Type | Organization
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Legal Business Name | LIFEGUARD AIR AMBULANCE, INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 4211 JERRY L MAYGARDEN RD
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City | PENSACOLA
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State | FL
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Zip | 32504-5029
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Country | US
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Telephone | 850-473-6776
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Fax | 850-473-6772
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | GULF BREEZE
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State | FL
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Zip | 32562-0487
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Country | US
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Telephone | 850-473-6776
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Fax | 850-473-6772
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Authorized Official
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Title or Position | FLIGHT COORDINATOR
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Name | MRS. MARY FLAKE
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Credential |
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Telephone | 850-473-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number | 150709
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License Number State | FL
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